South Dakota Medicaid: Impacts of the Federal Reconciliation Bill, H.R.1

Retroactive Coverage or “Backdating”

Currently: Medicaid coverage to be backdated up to 3 months prior to application.

Effective January 1, 2027: Retroactive coverage will be limited to:

• 1 month for adults eligible for Medicaid Expansion.
• 2 months for adults and children eligible for any other coverage group.

All Medicaid and CHIP applicants

Community Engagement or “Work Requirements”

Currently: There are no community engagement or work requirements for Medicaid Expansion.

Effective January 1, 2027: Persons must meet one of the following qualifying activities to be enrolled in Medicaid Expansion:

• Complete 80 hours a month of work, community service, work program participation, or a combination of these.
• Have monthly income equal to 80 hours of work at the Federal minimum wage (seasonal workers are averaged over 6 months)
• Be enrolled in school at least half time.

Medicaid Expansion applicants and enrollees, unless exempt.

Exemptions include:

• American Indians and Alaska Natives.
• Meeting SNAP or TANF work requirements.
• Caring for a disabled person of any age or a dependent child aged 13 or younger.
• Eligible for pregnancy/postpartum Medicaid coverage. 
• Disabled or meet certain medical requirements.
• Incarcerated currently or within 90 days.

More Frequent Renewals

Currently: Eligibility renewals are scheduled every 12 months.

Effective January 1, 2027: Eligibility renewals will be:

• Every 6 months for Medicaid Expansion enrollees.
• Every 12 months for adults and children enrolled in any other coverage group.

Medicaid Expansion enrollees. American Indians and Alaska Natives are exempt.

Cost Sharing Requirements for Certain Services

Currently: There are no cost sharing requirements.*

Effective October 1, 2028: Medicaid Expansion enrollees with income at or above 100% of the Federal Poverty Level will have cost shares for non-exempt services. This will not be more than 5% of a family’s income.

Exempt services include primary care, prenatal care, pediatric care, necessary emergency room care, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), mental health, and substance use disorder.

Medicaid Expansion enrollees. American Indians and Alaska Natives are exempt.